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Monday, October 25, 2010

We received nearly 13,000 calls last month to our free hotline for Washington residents with problems or questions involving insurance. Along the way, we helped consumers recover $776,937 in delayed/denied claims and similar problems.

We have experts in a wide variety of insurance matters, and we can often help resolve difficulties getting claims paid, help you find health coverage, etc.

We're not an insurer, agent or broker. We're the state agency that regulates the insurance industry in Washington state. We tend to get between 11,000 and 15,000 calls a month.

Got a problem or question? Give us a call: 1-800-562-6900 or e-mail us at AskMike@oic.wa.gov.

Friday, October 22, 2010

The National Weather Service has issued a "special weather statement" for much of western Washington late this weekend. From it:

A potent storm will slam into the region Saturday night and Sunday, resulting in locally heavy rain and strong winds, especially on the coast. Another blast of strong winds impacting a larger part of the area is possible on Monday.

If you experience damage and have insurance questions, try our winter weather information, which covers common insurance questions about everything from sinking boats to fallen trees to power outages.

Washington residents with insurance questions or problems can also call our consumer advocacy staff at 1-800-562-6900. We'll try to help.

Thursday, October 21, 2010

Washington State Insurance Commissioner Mike Kreidler today issued a cease and desist order against CHW Group, Inc., doing business as Choice Home Warranty and http://www.choicehomewarranty.com/.

The company is believed to have sold at least 92 home warranty service contracts to Washington residents. The contracts cover repair or replacement on major systems and appliances in the person's home, and promise that Choice Home Warrant will pay for repair or replacement of those that fail.

The problem: the company isn't authorized to transact insurance in Washington state. Nor is it registered here as a service contract provider.

Kreidler ordered the company to mail a copy of the order to all Washington home warranty service contract customers. The company must also report to the state how much it's collected in premiums from Washington consumers.

The company has the right to demand a hearing. The order takes effect today.

“Regence is in clear violation of state law that prohibits insurers from denying insurance to people on the basis of age,” said Kreidler. “I was shocked and deeply disappointed when Regence announced its decision last week to stop selling insurance to kids.”

The Affordable Care Act requires all health plans to cover kids with pre-existing conditions. However, to accommodate the insurance industry’s concerns that people would only enroll their children when they became sick, the federal government let states create a special open enrollment period.

Kreidler issued an emergency rule creating a special enrollment period from Nov. 1-Dec. 15. During this time, anyone looking for an individual health plan for their families or just their children can enroll their kids without having to take a health screen.

But Regence Blue Shield, the largest health insurer in the individual market, notified Kreidler on Sept. 27 that, effective Oct. 1, it would no longer sell individual health insurance policies to kids.

It is important to stress that our eligibility changes do not apply to those insured members covered under small or large group policies. We've been very clear that we will insure kids during open enrollment periods when the child is not the sole subscriber -- and we will do so regardless of health status.

A Tacoma woman who has repeatedly claimed to have slipped and fallen in grocery stores has been charged with theft and attempted theft after claiming to have fallen in two different stores within about 15 minutes.

Brenda J. Johnson, 50, is scheduled to be arraigned today in Pierce County Superior Court. She has been charged with first-degree theft and first-degree attempted theft.

Johnson said she was near check stand No. 2 at a Tacoma Safeway store on Sept. 18, 2009 at 11:46, buying peaches, when she slipped on some liquid and fell, injuring her wrist and ribs. Neither the cashier nor any other employee could recall any such incident.

On the same day at about noon, Johnson said the same thing happened in the frozen food aisle of a Tacoma Fred Meyer store.

In both cases, she said, she was embarrassed and quickly left. She filed claims with both stores, showing medical care and prescription drug receipts totalling more than $5,500.

A subsequent investigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit indicated that she apparently submitted virtually identical medical receipts to each store, including an 8-page emergency room report that was missing some pages.

Medical records obtained through a search warrant indicated that the treatment was unrelated to a fall at either store. The records also showed that there been no expense to Johnson for the care.

The investigation also revealed that Johnson has filed at least five auto-accident medical claims and at least half a dozen slip-and-fall injury claims.

Wednesday, October 13, 2010

A Lewis County couple have been sentenced to jail for filing a false insurance claim.

Jennifer Mau, 30, and David Eden, 47, were found guilty by a jury on Friday.

Their case began as a moving claim. They rented a U-Haul truck on March 30, 2007 to move their household goods and personal belongings from a Centralia storage facility to their new home. They claimed that the U-Haul truck leaked rainwater, destroying $16,789 worth of her property.

Mau reported the loss to U-Haul and filed a claim. The couple said they threw out the damaged property at a landfill.

The insurer had the U-Haul truck water tested for leaks. No leaks were found. The insurer, Republic Western Insurance, denied Mau's claim and turned the case over to state Insurance Commissioner Mike Kreidler's Special Investigations Unit. The SIU's investigation included checks with local weather stations, which reported little or no precipitation that night.

The court sentenced Mau to 60 days in jail, with the option of electronic home monitoring. Eden was sentenced to 15 days in jail. (Both sentences are stayed pending a possible appeal.)

The North Miami Beach company -- which was not registered as a service contract provider or insurer in Washington state -- nonetheless sold a contract to a Washington homeowner. He complained to us after he had difficulty getting them to pay for a repair to his stove. The company subsequently paid the claim.

Under the contract, Capital Home Shield, which is a doing-business-as name of MN Home Warranty Corp., promised to pay to repair or replace major systems and appliances that broke.

Kreidler ordered the company to to stop selling unauthorized contracts in Washington and to turn over a list of all its Washington clients, as well as reporting all premiums they've paid so far.

A 40-year-old Everett man who caused a three-car collision last fall has pleaded guilty to attempted insurance fraud, a gross misdemeanor.

On Oct. 8, 2009, Bieniek was driving his 1999 Ford F150 pickup. He'd owned it for about 5 years but didn't have insurance on it.

He claimed that just minutes before the collision, he'd picked up the truck from a friend in a parking lot, opened his laptop computer and bought insurance online from Geico Insurance.

But Geico, after pulling the company's online log, determined that Bieniek got the coverage after the wreck, not before. The company turned the case over to the Washington state insurance commissioner's Special Investigations Unit. Bieniek was charged with insurance fraud ("false claims or proof") in King County Superior Court in July.

On Friday, Bieniek pleaded guilty to attempted insurance fraud. He was sentenced to 6 months' probation, 120 hours of community service and a $500 victim penalty assesssment.

Tuesday, October 12, 2010

Not enough people know about it, but our consumer advocacy staff run a free phone hotline -- staffed by live people, not some endless phone tree -- to help you get answers to insurance questions and problems. It's 1-800-562-6900.

People call when they're unhappy with what their insurer's offering for their wrecked car, for example. They call, increasingly, because they cannot find affordable health coverage and are desperate to find coverage for loved ones. (We also have a special program, called Statewide Health Insurance Benefits Advisors, that trains hundreds of volunteers to help provide information on health insurance and Medicare options. They can be reached through the same number.)

One person called because he was unhappy with the value that an insurer put on his goat, which had met with an untimely end. (True. For what it's worth, we helped get him an extra $25 for his goat.)

Not everyone, however, speaks English-- or at least well enough to get into the details of an insurance claim and policy exclusions. So we have staff who can speak Spanish and Filipino/Tagalog, and others certified to interpret American Sign Language. We have a TTY machine. Some of our publications are available in Spanish, Chinese, Korean, Vietnamese and Russian.

And when that's not enough, we tap Language Line Services, a telephone interpreter service that can translate English into more than 150 languages (and vice versa) 24/7.

So if you know someone who's having trouble with an agent or insurer, needs help finding health coverage, etc., have them give us a call: 1-800-562-6900. We speak their language.

A Seattle women has pleaded guilty to filing a false claim in an insurance case -- a class C felony -- after allegedly smashing her van into two parked cars and then filing an insurance claim saying the van had been stolen.

Luom Vo, 38, was sentenced in King County Superior Court to 30 days community service and more than $4,000 in restitution and other costs.

According to Insurance Commissioner Mike Kreidler's Special Investigations Unit, Vo was driving on Seattle's Beacon Avenue just before 2 a.m. on Nov. 27, 2009 when she hit two parked vehicles: a Volvo station wagon and a Pontiac Vibe. Her Honda van was disabled in the crash. Neighbors said they saw Vo then climb into a friend's car and leave.

Later that day, Vo filed a claim with her insurer, PEMCO, saying that the van had been stolen. She subsequently insisted to a PEMCO investigator that she was not driving it when the crash happened.

The SIU investigation found that the van had not been stolen, and that she was, in fact, behind the wheel.

Monday, October 11, 2010

At least 129,973 Washingtonians are potential members of the settlement class in a class-action case that Farmers Group and corporate parent Zurich Financial Services Group have agreed to settle for $455 million.

The companies say payments "may vary considerably", but will average $35 per policyholder, and that some 13 million policyholders may qualify for a distribution under the settlement.

Customers with questions can contact Farmers regarding the settlement at 1-888-538-5785.

Here's our original post on this, with more details about the case and a link to Zurich's press release.

Friday, October 8, 2010

A Tacoma couple who filed a falsified insurance claim, including a forged receipt for a 57-inch TV allegedly purchased from a stranger for $5,800 in cash, have been sentenced.

They also claimed that burglars had stolen a $3,000 Persian rug they'd purchased from their next-door neighbor. When investigators from the state insurance commissioner's Special Investigations Unit questioned the neighbor, he said he'd never sold them a Persian rug, and that the couple was looking for someone to pretend to be the seller so they could collect money from their insurance company.

The couple, Melissa and Anthony Mezias, brought $8,800 in restitution to their sentencing hearing in Pierce County Superior Court on Monday.

In addition to full restitution, Anthony Mezias will have to pay more than $1,000 in court fees and costs on one charge of first-degree theft. Melissa Mezias will pay $700 in fees and costs on one count of attempted false claims in an insurance case.

Thursday, October 7, 2010

Zurich Financial Services Group said this morning that it and Farmers Group -- which it owns -- have "agreed in principle" to a $455 million settlement of a national class action lawsuit filed in California.

We're not sure yet how many of those 13 million people are in Washington state, although we're trying to find out. The settlement payments "may vary considerably," the company says, but will average $35 per policyholder.

What was the lawsuit about? Here's Zurich's summary:

In the lawsuit, the plaintiff challenged the management services fees paid by the Farmers Exchanges (Exchanges) to FGI and certain of its affiliates, which under policyholder subscription agreements act as the attorney-in-fact for policyholder subscribers of the Exchanges.

After our approval, policyholders entitled to participate in the settlement will be mailed notification, with more details. Customers can also contact Farmers regarding the settlement at 1-888-538-5785.

(Note: And thanks to the eagle-eyed reader -- and you know who you are -- who noted that "our" was misspelled "ourt" in the last paragraph. Fixed.)

Friday, October 1, 2010

The National Flood Insurance Program, a critical protection in many Washington communities, has been reauthorized for another year. President Barack Obama signed S. 3814 into law Thursday, extending the federal flood insurance program through Sept. 30, 2011.

“This can be important and affordable coverage for property owners and renters in flood-prone areas,” said Washington State Insurance Commissioner Mike Kreidler. Many lenders require flood coverage in order to qualify for mortgages in flood zones.

The program lapsed several times this year, and was slated to lapse again at the end of September. During lapses, flood policies remain in force for those who have them, but new policies cannot be written or renewed.

“While the program needs changes to make it more financially sustainable, this move by the President and Congress gives property owners another year of stability and protection,” said Kreidler.